Individual
JIN SEO PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2727 W OLYMPIC BLVD, 301, LOS ANGELES, CA 90006-2637
(213) 385-8000
Mailing address
2727 W OLYMPIC BLVD, 301, LOS ANGELES, CA 90006-2637
(213) 385-8000
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
47406
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D47406
CALIFORNIA CHILDRENS SERV
CA
Enumeration date
07/20/2007
Last updated
05/31/2012
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